Or does Binswanger perhaps think that treatment in. an institution, as recommended by him for cases of hysteria, cures the disease? We know, on the contrary, that although in numberless cases some distressing symptoms disappear during a stay in hospital, they reappear with renewed vigour directly the patients return to their old surroundings. Still that is no reason for rejecting hospital treatment. If we were to reject the remedies which only act symptomatically, and such that merely relieve the symptoms of disease for a time, we should have to abandon the largest part of therapeutics.

An objection occasionally made (Bruns) to hypnotic treatment or treatment by suggestion, is that in many cases cures apparently due to suggestion in reality occur spontaneously. .In many cases this objection is justifiable, but it applies equally to every other therapeutic method. I even believe that in the present day many really spontaneous cures are erroneously ascribed to the suggestive action of drugs. To many people the word "suggestion" has become a catch-word that will explain anything. In this way suggestion is accredited not only with any spontaneous improvement in cases of functional disorder, such as neurasthenia, but also with instances of temporary improvement where the disease is organic and progressive. In addition to spontaneous recovery, we have also to deal with certain fluctuations which may occur in cases of both functional and organic disease. A neurasthenic may be in a state of excitement for weeks, then quieter for weeks; his sleep may be disturbed at nights, and then he may recover spontaneously without any treatment. Such fluctuations, which sometimes have a regular and periodic character, may very easily be •mistaken for the suggestive action of any drug that has been exhibited.

The same is also the case in incurable organic diseases in which the symptoms by no means invariably present a regularly progressive character; on the contrary, essential symptoms sometimes abate for a time, without the organic disease showing any tendency towards improvement or cure. There are cases of tabes dorsalis in which the ataxy seems to abate for a long time, but that does not justify the conclusion that the organic disease is being cured. We observe the same sort of thing in chronic deformative rheumatism of the joints - the pains are at times less intense, but the swellings do not subside. It often occurs quite spontaneously and can easily be mistaken for the action of some remedy, including the action of suggestion if that has been employed at the same time. It cannot be doubted that such erroneous conclusions have often been drawn in medicine, - in electro-therapeusis, for instance. Paralysis of the muscles of the eye, an early symptom of tabes dorsalis, as a rule disappears spontaneously, and yet how often the improvement is attributed to electric treatment! And it has been pointed out very justly that we must carefully guard against such sources of error when judging the therapeutic value of suggestion.

But in spite of all this, no really objective investigator can doubt that there are numerous cases in which success is not due to any spontaneous improvement, but rather to the direct influence of hypnosis or hypnotic suggestion. If we take the case of a man suffering from insomnia, and his nightly sleep at all stages of the disease is improved by hypnotic, suggestion, we cannot call that a mere coincidence. No matter how sceptical we may be, there is always an essential something in the result, that is justly attributable to hypnosis.

Another objection to the therapeutic use of hypnosis is that it cannot be generally applied because everybody is not hypnotizable. To which I may add that in many cases, even when a hypnosis is induced, it is not deep enough to be used therapeutically. This, of course, reduces the number of cases in which hypnosis proves successful; but, on the other hand, the fact remains that hypnosis is practicable in many cases. We have only to consider the number of people who should, from a medical point of view, take a prolonged rest and yet are prevented from so doing by pecuniary or social reasons. Many people cannot afford the sea voyage, long stay in a sanatorium, healthy dwelling, etc., which would greatly improve their health.

In the early days a naive attempt was made to introduce an element of national feeling into the struggle against suggestive therapeutics and hypnotism. It was considered justifiable to speak ironically of "French professors of medicine," as Friedrich, for instance, did. A German author had previously made a chauvanistic protest that hypnotism originated in France, and it was frequently maintained that susceptibility to hypnosis was something French and could not possibly occur among Germans. This latter assumption was disproved long ago. But apart from this, Forel pointed out very properly that such talk is not permissible in scientific discussions. I have often known a French professor show himself up as Friedrich did on the question of hypnosis. The attempt to bring other nations into ridicule by ascribing to them quaint idiosyncrasies is a very old mania. As far as we are here specially concerned, I need only point out that in Mesmer's time the Germans accused the French of making mesmerism the basis of nothing but the wildest swindles.

In those days Mirabeau answered such attacks by calling attention to the so-called "moon-doctor," the stocking-knitter Weissleder, who caused such a stir in Berlin from 1780 to 1781: "As if we Frenchmen had not received the notorious Mesmer from the hands of the Germans, and the latter were not anxious to have their 'moon-doctor,' who was supposed to cure all diseases by the influence of that planet, forgotten" (Ave-Lallemant).

What therapeutic factors play a part in hypnotic treatment? Some think that hypnosis is in itself beneficial; this is the opinion of Beaunis, Obersteiner, and Wetterstrand, who employed hypnosis in the treatment of epilepsy, hystero-. epilepsy and other states. Later on Hirschlaff, Vogt, Brod-mann and others also expressed the opinion that the rest afforded by hypnosis is curative, because it strengthens the nervous system. Brodmann distinguishes three methods of employing hypnosis: (1) Prolonged sleep, (2) periodical sleep to prevent exhaustion or a pathologically increased tendency to fatigue, and (3) occasional sleep to ward off threatened attacks or suppress such as may exist (convulsions, pain, emotion).